| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,606 |
11,604 |
$531K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,619 |
3,486 |
$444K |
| D1120 |
Prophylaxis - child |
13,623 |
13,616 |
$427K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66,944 |
13,666 |
$282K |
| D2140 |
|
3,524 |
2,138 |
$192K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,103 |
15,097 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,621 |
2,620 |
$165K |
| D9993 |
|
2,398 |
2,398 |
$150K |
| D1351 |
Sealant - per tooth |
5,495 |
1,857 |
$127K |
| D1310 |
|
2,631 |
2,631 |
$120K |
| D0210 |
Intraoral - complete series of radiographic images |
2,506 |
2,505 |
$118K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,820 |
1,123 |
$104K |
| D2160 |
|
1,124 |
795 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,230 |
2,136 |
$88K |
| D1110 |
Prophylaxis - adult |
976 |
976 |
$85K |
| D0274 |
Bitewings - four radiographic images |
3,816 |
3,816 |
$81K |
| D0272 |
Bitewings - two radiographic images |
6,746 |
6,743 |
$79K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
546 |
382 |
$65K |
| D0350 |
|
5,357 |
2,991 |
$56K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
542 |
379 |
$54K |
| D1354 |
|
1,486 |
1,428 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,274 |
3,259 |
$38K |
| D0603 |
|
1,864 |
1,864 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
386 |
386 |
$23K |
| D9430 |
|
621 |
613 |
$20K |
| D2330 |
|
212 |
148 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
66 |
$8K |
| D4341 |
|
104 |
29 |
$7K |
| D0601 |
|
377 |
377 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
26 |
$3K |
| D0602 |
|
121 |
121 |
$2K |